Skip to main content
Other~10 min

Practising applied tension

Record clinician-taught muscle tension, signs of faintness and agreed practice with blood, injection or injury fears.

Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed

Assign to a clientDownload PDFTry the preview ↓

Assign and Download open signup, then return you to this worksheet. No card required. Resource access depends on your plan or trial. Already have an account? Sign in

Worksheet preview

Preview
Learn applied tension with a clinician before using this record. It means tensing muscles to raise blood pressure when you are prone to fainting around blood, injections or injuries. Check with your GP first if you have high blood pressure, a heart condition or are pregnant. Before starting, use the safe, supported position and support arrangements agreed with your clinician. Use only the technique and exposure steps they have agreed. Record their instructions, including muscle groups, timing, release and breathing normally. Do not hold your breath or strain. Sit or lie down if you feel faint; pause the practice and tell your clinician. New, unexplained or repeated fainting needs medical assessment. Seek urgent medical help if symptoms persist.

Live preview — type in any field to try it. Nothing is saved here.

One agreed practice

Try it here — nothing you type is saved. Sign up to assign it and let clients complete it on any device.

When to use ‘Practising applied tension’

‘Practising applied tension’ is an interactive cognitive behavioural therapy (CBT) worksheet. As a core CBT skill it is used right across the model, with presentations including depression, anxiety, OCD, trauma and low self-esteem, rather than being tied to a single diagnosis.

It is designed to be used within therapy rather than as a standalone self-help tool: a therapist introduces it, works through it collaboratively, and helps make sense of what it surfaces. You can preview the full worksheet above, then assign it digitally for clients to complete between sessions on any device or download it as a print-ready PDF.

How it works

Most people work through it in around 10 minutes. It centres on one focused exercise:

  1. One agreed practice

Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.

The CBT approach behind it

In common with other CBT methods, ‘Practising applied tension’ works by gradually and safely facing avoided situations so anxiety can subside (exposure). The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.

Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.

Evidence & sources

This worksheet is grounded in established cognitive behavioural therapy theory and practice. Key sources include:

  • Öst, L.-G., & Sterner, U. (1987). Applied tension: A specific behavioral method for treatment of blood phobia. Behaviour Research and Therapy.
  • Ayala, E. S., Meuret, A. E., & Ritz, T. (2009). Treatments for blood-injury-injection phobia: A critical review of current evidence. Journal of Psychiatric Research.

For use alongside professional support

Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.

If you need urgent help now:

  • Emergency services: 999 — if you or someone else is in immediate danger
  • NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
  • Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
  • Samaritans: 116 123 — free, day or night, 365 days a year
  • Shout: 85258 — text SHOUT, free, day or night
  • SANEline: 0300 304 7000 — 4pm–10pm, every day

Want to assign this to a client?

Create a free therapist account to use the homework and library download tools. Clients can complete assigned homework online or use a blank PDF. See how the homework workflow works.

Create free accountBrowse the library

No card required. The Free plan includes 10 worksheet uses a month. Check plan access and limits.